| NPI | 1316543986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 27340) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH18901) |
| Enumeration Date | 2020-12-09 |
| Last Update Date | 2020-12-09 |